Bruno Cancer Center Cancer Program

Transcription

1 Bruno Cancer Center Cancer Program 29 Annual Report & 28 Statistical Review

2 CALL TO ACTION Healthcare That Works Healthcare That is Safe Healthcare That Leaves No One Behind For Life CORE VALUES We are called to: Service of the Poor Reverence Integrity Wisdom Creativity Dedication ENABLING STRENGTHS Inspired People Trusted Partnerships Empowering Knowledge Vital Presence Stewardship

3 St. Vincent s Bruno Cancer Center Chairperson s Annual Report Susan Salter, M.D. As Chairperson of the Cancer Committee, I am pleased to present the 29 Annual Report summarizing the 28 Cancer Program at St. Vincent s Birmingham. A patient-centered program with a commitment to excellence, St. Vincent s Bruno Cancer Center experienced another year of growth in patient care. We diagnosed and managed over,8 cancers in 28. As expected, these were predominantly prostate, breast, colorectal, lung, lymphomas, oral cavity, and a variety of hematologic conditions. Most of the patients were primarily treated with surgery, but more than half received radiation therapy, chemotherapy, or antibody therapy as their primary or adjuvant treatments in the Bruno Cancer Center. Last year, St. Vincent s Cancer Program received a Three-year Approval with Commendations by The Commission on Cancer (CoC) of the American College of Surgeons for demonstrating multidisciplinary patient care and complying with quality standards set to improve cancer care outcomes. Our CoC-approved cancer program ensures patients will have access to comprehensive care, including a range of state-of-theart services and equipment and we offer a multi-specialty team approach to coordinate the best treatment options. Earning CoC approval is an important accomplishment for our cancer program, but more importantly this recognition highlights our commitment and delivery of quality cancer care. In addition, our cancer program is designated as a Community Hospital Comprehensive Cancer Center by the Commission on Cancer. This designation is awarded to cancer programs that meet the highest standards of practice in all aspects of cancer care offering a full range of diagnostic and treatment services, participating in clinical trials, and having more than 65 newly diagnosed cancer cases each year. Our Cancer Registry works tirelessly to capture a complete summary of every cancer patient s history, diagnosis, treatment, and status and maintains our database so we can better understand the patterns and etiology of cancer. St. Vincent s Bruno Cancer Center continues to offer Partial Breast Irradiation treatment with Contura devices. This allows us to treat selected breast cancer patients in a shorter time frame, from seven weeks to one week. A Contura balloon allows us to fill the empty space left by a lumpectomy breast procedure. The breast tissue that needs treatment will then be vacuum-sealed around the Contura radiation balloon. A targeted radiation dose is then administered only where it is needed in the breast, sparing exposure to otherwise normal breast tissue. Offering Partial Breast Irradiation dramatically cuts treatment time for our patients and minimizes damage to healthy breast and surrounding tissues. The Medical Oncology Center program remained robust in clinic activities and clinical research. There were more than 3, patient visits and 7,4 treatments (primarily chemotherapy) administered in the Bruno Cancer Center. Also, our Talladega Clinic saw over, patients and administered over 4 treatments. Medical oncology clinical trials involved a variety of cancer types and therapies including new agents in late phase trials for FDA approval. Center stage among trials was Abiraterone, an oral agent for treatment of refractory prostate cancer. The Bruno Cancer Center functioned as a principle investigative site for this international trial that demonstrated significant activity for this treatment, which will be the basis for FDA approval of the drug in 2. In a phase III study of FUO248 (small molecule inhibitor of VEGFR) in combination with Paclitaxel was given to patients with recurrent breast cancer. Amplimexon, a new cytotoxic chemotherapy, was given in combination with Gemcitabine for treatment of pancreatic cancer. ApO 2L/TRAIL, a tumor necrosis factor inducing protein was given in combination with Rituximab to patients with numerous types of lymphoma. An open label trial of E7389, synthetic analog of the chemotherapy drug Halichondrin B, was given to patients with pretreated metastatic breast cancer. Overall, the center treated 47 patients on different investigational protocols.

4 CANCER COMMITTEE 29-2 St. Vincent s Bruno Cancer Center Chairperson s Annual Report (continued) The medical oncology service continues its long standing policy of aggressively pursuing state-of-the-art standard therapies and investigational therapies for our patients at top tier cancer centers, including MD Anderson, Vanderbilt University, and Mayo Clinic, along with numerous others. We have established collaborative efforts with these institutions and others along with our in-house clinical research program in order to provide the Bruno Center cancer patients with state-of-the-art treatment options. We are pleased to welcome Kris Boone to our center as our new Cancer Center Manager. She has served in various roles at St. Vincent s over the past 5 years and we are glad she has joined our team in the Cancer Center. Since early detection is one of the best defenses against cancer, The Bruno Cancer Center organized and executed two successful free cancer screenings for the community in 28. The skin cancer screening was held in June and we had 94 participants with 29 of those requiring further followup. Robert Pritchett, MD, Matthew Abele, MD, Janet Cash, MD, and Alan Cook, MD volunteered their time to conduct the screening. A free prostate cancer screening was held in September last year. We had 68 participants and 3 of those had abnormal results which required further evaluation. Thanks to Leon Hamrick, MD., Scott Tully, MD, and Jason Moellinger, MD for conducting the screening. Cancer prevention activities were also supported by St. Vincent s Birmingham associates who work in the Bruno Cancer Center. They supported the Saks Key to the Cure event, American Cancer Society s Relay for Life, Brenda Ladun s Conquer Cancer Run, the Susan G. Komen Race for the Cure, the Leukemia and Lymphoma Society s Light the Night Walk, and other various fundraising events that support cancer patients and their families as well as cancer research. I am extremely proud of our associates who have taken the time and energy to support these events. Other screenings, education, and support group programs continue to enhance our cancer program including our Breast Cancer Support Group, General Cancer Support Group, and Camp Bluebird, our annual retreat for cancer survivors. We appreciate the support of The St. Vincent s Birmingham Foundation which ensures our cancer patients needs are met through their diagnosis, treatment, and recovery. The Bruno Cancer Center remains steadfast in our mission to provide care you can believe in. Susan Salter, M.D. Susan Salter, MD Cancer Committee Chairman Matthew Abele, MD Dermatology J. Max Austin, MD Gynecologic Oncology Allyson Baker, MD Pathology Mack Barnes, MD Gynecologic Oncology Sheldon Black, MD Otolaryngology John Blalock, Jr., MD General Surgery Cara Bondly, MD Hematology/Oncology Tom Brown, MD Internal Medicine Gray Buck, III, MD General Surgery Charles Bugg, Jr., MD Urology Philip Fischer II, MD General Surgery Jon David Holmes, MD Oral/Maxillofacial Surgery Jason Moellinger, MD Urology Robert Pritchett, MD Dermatology Jill Rutherford, MD Radiology Sally Salter, MD General Surgery James Strickland, Jr., MD Pulmonary Disease Edward Butch Pair Clinical Excellence Sheila Grant, RHIA, CTR Cancer Registry Coordinator Rosalind Patterson, RHIT, CTR Cancer Registry Diane Lolley, RHIT Cancer Registry Andy Davis Administration Jeff Daniel Administrative Director of Clinical Services Kris Boone Cancer Center Manager Cathleen Dixon, MSW Social Services Diane Cherry, RN Oncology Unit Janice Simmons, RN Oncology Unit Manager Kimberly Rider Wellness Services Jessica Tuggle American Cancer Society

5 St. Vincent s Birmingham Cancer Program St. Vincent s Cancer Program St. Vincent s Cancer Program is accredited by the Commission on Cancer (CoC) approval program as a Community Hospital Comprehensive Cancer Program (COMP). The cancer program has five key elements that make it a successful program: Cancer Committee leads the program by setting annual goals, monitoring activity, evaluating patient outcomes, improving patient care, as well as hosting community outreach screenings such as Prostate Cancer and Skin Cancer. Clinical Services provide state-of-the-art pre-treatment evaluation, staging, treatment, and clinical follow-up for cancer patients seen at the facility for primary, secondary, tertiary, or quaternary care. Cancer Conferences provide a forum for patient consultation through discussion of up-to-date techniques and treatment options for cancer patients as well as a form of education for medical staff and ancillary personnel. quality Improvement program is the mechanism for evaluating and improving patient outcomes. Annually, the Cancer Committee discusses clinical areas or cancer sites to be reviewed throughout the year. As a COMP Cancer Program, annually the program is responsible for collecting data for two quality Studies and two quality Improvements. Cancer Registry is a hospital-based cancer registry designed to collect, analyze, and manage data on malignant cancers, benign central nervous system, and other reportable diseases. There is an extensive amount of data collected in the registry from demographics, cancer origination, stage of disease, and type of medical treatment given to provide quality outcome data. The Cancer Registry staff consists of 3. FTE s, of which two registrars are Certified Tumor Registrars (CTR) and one CTR-eligible. In 28, the Registry collected,89 new cases in which,742 cases were diagnosed and treated at St. Vincent s Birmingham. The top five treated site are Prostate, Breast, Colon, Lung, and Oral Cavity. The registry continues to strive for excellence in maintaining a follow-up rate of ninetyone percent. This is accomplished by working with physician offices and calling patients to collect follow-up data on over 5,5 patients in the database on an annual basis. In efforts to maintain quality data, the cancer registry data is submitted and reviewed by the Alabama Statewide Cancer Registry on a monthly basis and annually to the National Cancer Database s Call for Data. The Cancer Registry works diligently to assist the Cancer Program by maintaining compliance with the American College of Surgeons Commission on Cancer standards for approved programs.

6 Charts and Graphs Top 5 Site Comparison St. Vincent s Birmingham Top Ten Cancer Sites by Sex MALES. Prostate 2. Lung & Bronchus 3. Colon & Rectum 4. Oral Cavity 5. Urinary Bladder 6. Non-Hodgkin Lymphoma 7. Kidney & Renal Pelvis 8. Melanoma - Skin 9. Larynx. Leukemia FEMALES. Breast 2. Colon & Rectum 3. Lung & Bronchus 4. Oral Cavity 5. Corpus Uteri 6. Unknown Primary 7. Non-Hodgkin Lymphoma 8. Brain & Other Nervous System 9. Kidney & Renal Pelvis. Thyroid

7 New Advancement in Accelerated Partial Breast Radiation: Treatment in Five Days Susan Salter, MD Radiation Oncologist For many years, surgery has been the first line of attack against breast cancer. Today, targeted surgery can often be offered to preserve as much of the healthy breast and surrounding tissues as possible, conserving the breast. As Breast-Conserving Therapy (BCT) continues to evolve, new treatment techniques offer decreased overall treatment time, optimize homogeneity of dose delivery and improved targeted radiation dosage. St. Vincent s Bruno Cancer Center offers a new technique called Accelerated Partial Breast Irradiation (APBI). This new technique has been studied by our staff to determine whether these outcomes can be achieved, considering that 7% to 8% of in-breast failures following BCT occur in the immediate vicinity of the lumpectomy cavity. Initial studies were performed using multi-catheter Interstitial Brachytherapy (IB), with a median follow-up of five years or longer. These reports have been very encouraging, suggesting that APBI is comparable to whole-breast irradiation in both safety and efficacy. There are several modalities for performing APBI. These include interstitial brachytherapy (IB), balloon catheter systems, CT-based conformal external beam techniques, and intraoperative electron beam therapy. One such new technique for APBI is a balloon brachytherapy catheter. It consists of a double-lumen catheter with an inflatable balloon at the distal tip. (picture left) The balloon is placed in the lumpectomy cavity at the time of surgery. A high dose-rate source is then inserted through the inner lumen into the center of the balloon, and radiation is delivered to the shell of the tissue surrounding the lumpectomy cavity, in an effort to target the post-surgical tumor bed with a margin of adjacent breast tissue using accelerated schedules over a shorter duration of time. (picture below right) This technique allows patients to be treated two times a day for five days as opposed to daily treatments lasting five to seven weeks with external beam radiation therapy. Most patients find the balloon catheter easier to tolerate than Interstitial Brachytherapy procedure. Cosmetic outcomes have been very good to excellent in the vast majority of patients seen and the dramatic decrease in treatment time assures an option for administering irradiation after breast-conserving surgery in our ever changing, fast paced society. St. Vincent s Bruno Cancer Center has been performing accelerated partial breast irradiation therapy since 24. More than 2 patients have been treated at St. Vincent s using APBI and only one of those patients has had a local recurrence of breast cancer. Our infection rate is also low and the majority of cosmetic results have been excellent.

8 Breast Cancer Survival Graphs St. Vincent s Birmingham Observed Breast Cancer Survival by AJCC Stage Observed Survival For Cases Diagnosed in Data from 559 Facilities [Comprehensive Community Cancer Center]

9 Cancer Summary by County The top fi ve counties served in 28 were Jefferson, Shelby, Walker, St. Clair, and Cullman. Of the,89 cases treated, 46 were referred to St. Vincent s Birmingham from outside the state of Alabama. COLBERT FRANKLIN LAUDERDALE LAWRENCE LIMESTONE MORGAN MARION WINSTON CULLMAN LAMAR PICKENS SUMTER 3 CHOCTAW GREENE WASHINGTON MOBILE 3 FAYETTE TUSCALOOSA HALE WALKER PERRY BIBB DALLAS MARENGO WILCOX CLARKE BALDWIN JEFFERSON MADISON BLOUNT SHELBY CHILTON AUTAUGA LOWNDES MONROE BUTLER ESCAMBIA MARSHALL 36 ST. CLAIR 58 JACKSON ETOWAH TALLADEGA 2 COOSA DEKALB CALHOUN CHEROKEE CLEBURN CLAY RANDOLPH CHAMBERS TALLAPOOSA 27 LEE ELMORE MACON MONTGOMERY 34 2 PIKE BULLOCK RUSSELL BARBOUR CRENSHAW HENRY DALE CONECUH COFFEE COVINGTON HOUSTON GENEVA

10 Primary Site Tabulation for 28 Analytic Cases 28 ANALYTIC SITE DISTRIBUTION PRIMARY SITE TOTAL SEX STAGE GROUP M F I II III IV 88 UNK ORAL CAVITY TONSIL SALIVARY GLANDS OROPHARYNX NASOPHARYNX 2 2 HYPOPHARYNX ESOPHAGUS STOMACH SMALL INTESTINE COLON AND RECTUM ANUS, ANAL CANAL & ANORECTUM 3 3 LIVER & INTRAHEPATIC BILE DUCT GALLBLADDER 2 2 OTHER BILIARY PANCREAS PERITONEUM, OMENTUM & MESENTERY NASAL CAVITY, MIDDLE EAR & ACCESSORY SINUSES LARYNX LUNG & BRONCHUS BONES & JOINTS SOFT TISSUE (INCLUDING HEART) MELANOMA SKIN OTHER NONEPITHELIAL SKIN BASAL/SqUAMOUS CELL CARCINOMAS OF SKIN 2 2 BREAST CERVIX UTERI CORPUS UTERI OVARY 5 4 VULVA OTHER FEMALE GENITAL ORGANS PROSTATE TESTIS PENIS OTHER MALE GENITAL ORGANS URINARY BLADDER KIDNEY & RENAL PELVIS URETER 2 EYE & ORBIT BENIGN BRAIN & OTHER NERVOUS SYSTEM MALIGNANT BRAIN & OTHER NERVOUS SYSTEM THYROID OTHER ENDOCRINE (INCLUDING THYMUS) HODGKIN LYMPHOMA 2 NON-HODGKIN LYMPHOMA MULTIPLE MYELOMA LEUKEMIA MESOTHELIOMA KAPOSI SARCOMA UNKNOWN PRIMARY TOTAL ANALTyIC, TOTAL CASES,89,

11 Bruno Cancer Center 8 St. Vincent s Drive Birmingham, Alabama